Long‐term vaginal ring pessary use: discontinuation rates and adverse events

• Published in: BJOG : an international journal of obstetrics and gynaecology Vol. 116; no. 13; pp. 1715 - 1721
• Main Authors: Sarma, S, Ying, T, Moore, KH
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.2009; Blackwell; Wiley Subscription Services, Inc
• Subjects: Adult; Adverse events; Aged; Aged, 80 and over; Biological and medical sciences; discontinuation rates; Equipment Design; Female; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Hemorrhage - etiology; Humans; long‐term complications; Medical equipment; Medical sciences; Middle Aged; Patient Dropouts - statistics & numerical data; Pessaries - adverse effects; Reproductive system; Retrospective Studies; Side effects; Time Factors; Urinary Incontinence, Stress - therapy; Uterine Prolapse - therapy; Vaginal Diseases - etiology; vaginal ring pessary; Women; Interruption; Pessary; Toxicity; Ring; Gynecology; Secondary effect; Vagina; Long term; Obstetrics
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2009.02380.x

Objective  To evaluate, at a minimum of 6 years, the long‐term discontinuation rates and incidence of adverse events associated with vaginal ring pessary use. Design  Retrospective case identification. Setting  Tertiary urogynaecology unit. Sample  All women fitted with either a Portex ring pessary or Introl bladder neck support device during the index period (1992–2002). Methods  Retrospective chart review. Main outcome measures  Length of use and complications of pessary use, including bleeding, extrusion, malodorous vaginal discharge, constipation and incontinence. Results  Of the 273 women fitted with a ring pessary, 167 were successfully using it at 4 weeks; subsequently, 93 (56%) experienced complications comprising bleeding, extrusion, severe vaginal discharge, pain and constipation, in that order, although 38 women (23%) had more than one type of complication and most had more than one episode. Only 23 of 167 (14%) continued with pessary use at the study endpoint (November 2008). The median duration of use was 7 years (interquartile range, 6–9 years; range, 2.25–13.9 years). Of those who discontinued, the median duration was 1.4 years (range, 0.1–11 years; interquartile range, 0.5–3.6 years). After cessation, 73 (44%) chose conservative treatment and 50 (30%) chose surgery. Twelve women died during the time frame; nine returned to their GP. Conclusions  We were surprised to find a 56% complication rate in pessary users. Our study shows that, over time, the majority of women chose to discontinue using pessaries. Women should be informed of these data when deciding on the management of their pelvic organ prolapse.